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The American Health Care Act Threatens the Continued Growth of Home and Community-Based Services

The American Health Care Act (AHCA) proposes to cap Federal Medicaid reimbursements to the states on a per-enrollee basis, effectively limiting growth to a rate only modestly exceeding the rate of inflation in healthcare costs. A new CLPC policy brief analyzes the potential impact of these caps on home and community-based services (HCBS) spending. This report uses state-by-state HCBS expenditures from 2001 through 2013 and compares the growth in spending during those years to the limitations that would have been in place had AHCA-like caps been imposed during those years. Findings indicate that caps would likely have caused the vast majority of states to limit HCBS growth, reducing increases in per-enrollee spending to substantially below the increases that actually occurred. By 2013, HCBS spending for people with physical disabilities, seniors, and other non-developmental disabilities would probably have been reduced by between 19% and 28% below actual spending. For programs targeted to people with intellectual or developmental disabilities, reductions of up to 13% would have occurred.